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Compliance with universal precautions
d!G Volume
21,
Number
2
COMPLIANCE WlTH UNIVERSALPRECAUTIONS. Baptist Hospital, Paducah, KY.
D. Hayden, RN. Western
Background: Healthcare workers (HCW) caring for sick patients place themselves at risk for acquiring transmissible infections. The purpose of this study was to explore the level of integration of universal precautions (UP) in the practice of HCWs in the emergency room (ER), and critical care unit (CCU) in a rural community hospital. Method: Direct observation of HCWs working in ER and CCU using the assessment tool developed by Gauthier, et.al. was employed for this study. The results were calculated into compliance percentages by unit and by four aspects of UP protocol. The subjects were intendiewed for opinion regarding UP. Results: A total of IO HCWs were observed caring for 34 patients with 112 chances to exercise UP. When calculated by activity and unit, the results were overall 63%; barriers ER 89% and CCU 58%; handwashing ER 45% and CCU 62%; and disposal ER 59% and CCU 77%. All subjects stated that personal protectiveequipment (PPE) was adequate, appropriate and available. The two most frequently mentioned reason to wear PPE was fear of infection and inservice education, while the most common reason lnot to wear PPE was improper fit. Conclusion: The HCWs overall compliance rate was 63% and within the range of published studies. Compliance rates help define problems related to implementing UP
THE EFFECT OF EDUCATION AND SURGEON-SPECIFIC FEEDBACK ON COMPLIANCE WlTH THE USE OF PROTECTIVE MATERIALS BY ORTHOPAEDIC SURGEONS AND SURGICAL TEAM MEMBERS. M. Spencer, RN, MM, CIC,* D. Ford, RN, MPH, K. Bymes, RN, MSN, H. Mankin, MD, C.C. Hopkins, MD, Massachusetts General Hospital, Boston, MA, A pilot study was conducted to evaluate the independent effect of targeted education and surgeon-specific feedback on compliance wth the use of protective barriers during surgery, using a factorial design. Orthopaedic surgeons and surgical team members were observed by an orthopaedic nurse supervisor over a 12 week period (July 15 - October 4, 1991). Twenty-five (25) otthopaedic surgeons were randomly assigned to one of four study groups: control, education, feedback, and education and feedback. Twenty-three (23) agreed to participate. There were 1674 operating room observations collected as follows: orthopaedic surgeons, 280; orthopaedic residents, 482; scrub technicians, 300; and anesthesia staff, 323. Compliance rates for the first six weeks were compared with the last six weeks of the study: impervious disposable gowns were used more often in all study groups, but with higher compliance rates in the intervention groups: Mean Comphance Rates for Impervious Disposable Gown Use Weeks I - 6 Weeks 7 I2 Surgeons Residents Scrub Tech
35% 33% 10%
58% 59% 17%
Protective eyewear demonstrated no differences in compliance rates between the two time periods (40% and 45% respectively). Double gloves were used consistently throughmu the study by surgeons (83%); residents (84%); and scrub technicians (82%). Single gloves were infreqilently used by circulating nwses (13%) and anesthesia (25%). The study design and edticational interventions will be presented with a recommendation to replicate the study. An increased sample size, to include the stratification of 00ier surgical subspecialties, will provide a more representative sample and power for analysis of mteraction effects.
A STUDY THAT EXAMINES TWO PRESENTATION METHODS IN MEETING INFECTION CONTROL EDUCATlON REQUIREMENTS. M. McCormick, MD, M. Gardenhire, RN, MSN, E. Hood, RN, BSHCM, CIC,* E. Steimke, RN, MSN, CIC. VAMC and Medical College of Augusta, Augusta, GA. The Occupational Safety arid Health Administration’s final rule on “occupational exposure” requires the presence of a trained individual for education. This study compares the difference in post tes: scol-es when education is presented in person as opposed to on video. The sample included 492 Nursing s&ff, The 10 question test sought to evaluate knowledge of exposure risk. OSHA regulations, risk of HIV and HBV infecnon, and use of personal protective equipment. Verbal presentations were given by Infection Control Practitioners to 234 attendees; 25X attended a video presentation. Identical pre and post tests were given to both groups. Questions and answers were withheld from the video group until after the post test. Statistical analysis of both groups pretest scores revealed no difference at the 95% confidence level. Results: Post test scores of both groups were lugher than pretest scores, with a significant difference noted at the 95% confidence level. The average post test scme of the video group was higher than the oral group. however there was no significant difference at the 95% confidence levei. Goal-oriented programs on video result in learning, and are necessary Imethods with increasing requirements for education, and with time and personnel constraints.
EVALUATION OF THREE NEEDLE-LESS INTRAVENOUS THERAPY DEVICES. E. Owens, BSN,* E. Iademarco, BSN, M. Jones, BSN, S. O’Rourke, BSN, V. Fraser, MD. Barnes Hospital and Washington University Medical Center, St. Louis, MO. OSHA’s Bloodborne Pathogen Standard mandates engineering conlrols to limit needlestick injury (NSI). Multiple needle-less devices (NLD) have been recently introduced, however there is little data documentating product efficacy. We evaluated three needle-less intravenous therapy ([VT) systems for their efficacy in decreasing NSI in health care workers; 1) a ~metalblunt cannula (“Lifeshield,” Abbott Laboratories, Chicago, IL), 2) a plastic two-way valve system (“&f-Site,” Burron Medical, Bethlehem, PA), 3) a plastic blunt cannula (“Interlink,” BaxteriBD, Deerfield, IL). These deuces eliminate needies used to access IVT systems but do not elimmate the need for IV catheters, needles for injections, or phlebotomy needles. Barnes Hospttal is a 1000 bed tertiary care hospital with 54 nursing units and 600 reported NSIiyear. Between 6192 and 12192, 6 Imatched pairs of nursing units were prospectively randomwd to traditional IVT (control) or to one of three needle-less IVT systems (study). Ail umts received needle safety teaching, an on site NSI log for convenient reporting, and biweekly visits from infection control to promote NSI reporting. 20 NSI were reported from all areas during the study period. 15 (75%) of the reported NSI were related to activities that could have been prevented by a NLD. Activities included IV piggy back needle handling (30%), handling needles for line flush (15%). handhng loose needles (15%), blood drawing from a central (lo%), and needle disposal (5%). The Imetal blunt cannula group had 5 NSI compared to 3 in the control site @=NS). The iwo-way valve system had 0 NSI and their control group had 5 NSI (p=.O6223). The plastic blunt cannula study group had 0 NSI and the control grwp had 5 @=.01067). The metal blunt cannula group actually had more NSI than traditional IVT systems. The 2.way valve system had fewer NSI than their control group but this was only marginally significant. The plastic blunt cannula group had significantly fewer NSI than their control group. Differences in study groups were controlled by patient days and number of employees, but were difticult to assess given the small numbers of NSI. Further studies of these new devices are necessary to document their efficacy and justify their cost.
21,
Number
2
COMPLIANCE WlTH UNIVERSALPRECAUTIONS. Baptist Hospital, Paducah, KY.
D. Hayden, RN. Western
Background: Healthcare workers (HCW) caring for sick patients place themselves at risk for acquiring transmissible infections. The purpose of this study was to explore the level of integration of universal precautions (UP) in the practice of HCWs in the emergency room (ER), and critical care unit (CCU) in a rural community hospital. Method: Direct observation of HCWs working in ER and CCU using the assessment tool developed by Gauthier, et.al. was employed for this study. The results were calculated into compliance percentages by unit and by four aspects of UP protocol. The subjects were intendiewed for opinion regarding UP. Results: A total of IO HCWs were observed caring for 34 patients with 112 chances to exercise UP. When calculated by activity and unit, the results were overall 63%; barriers ER 89% and CCU 58%; handwashing ER 45% and CCU 62%; and disposal ER 59% and CCU 77%. All subjects stated that personal protectiveequipment (PPE) was adequate, appropriate and available. The two most frequently mentioned reason to wear PPE was fear of infection and inservice education, while the most common reason lnot to wear PPE was improper fit. Conclusion: The HCWs overall compliance rate was 63% and within the range of published studies. Compliance rates help define problems related to implementing UP
THE EFFECT OF EDUCATION AND SURGEON-SPECIFIC FEEDBACK ON COMPLIANCE WlTH THE USE OF PROTECTIVE MATERIALS BY ORTHOPAEDIC SURGEONS AND SURGICAL TEAM MEMBERS. M. Spencer, RN, MM, CIC,* D. Ford, RN, MPH, K. Bymes, RN, MSN, H. Mankin, MD, C.C. Hopkins, MD, Massachusetts General Hospital, Boston, MA, A pilot study was conducted to evaluate the independent effect of targeted education and surgeon-specific feedback on compliance wth the use of protective barriers during surgery, using a factorial design. Orthopaedic surgeons and surgical team members were observed by an orthopaedic nurse supervisor over a 12 week period (July 15 - October 4, 1991). Twenty-five (25) otthopaedic surgeons were randomly assigned to one of four study groups: control, education, feedback, and education and feedback. Twenty-three (23) agreed to participate. There were 1674 operating room observations collected as follows: orthopaedic surgeons, 280; orthopaedic residents, 482; scrub technicians, 300; and anesthesia staff, 323. Compliance rates for the first six weeks were compared with the last six weeks of the study: impervious disposable gowns were used more often in all study groups, but with higher compliance rates in the intervention groups: Mean Comphance Rates for Impervious Disposable Gown Use Weeks I - 6 Weeks 7 I2 Surgeons Residents Scrub Tech
35% 33% 10%
58% 59% 17%
Protective eyewear demonstrated no differences in compliance rates between the two time periods (40% and 45% respectively). Double gloves were used consistently throughmu the study by surgeons (83%); residents (84%); and scrub technicians (82%). Single gloves were infreqilently used by circulating nwses (13%) and anesthesia (25%). The study design and edticational interventions will be presented with a recommendation to replicate the study. An increased sample size, to include the stratification of 00ier surgical subspecialties, will provide a more representative sample and power for analysis of mteraction effects.
A STUDY THAT EXAMINES TWO PRESENTATION METHODS IN MEETING INFECTION CONTROL EDUCATlON REQUIREMENTS. M. McCormick, MD, M. Gardenhire, RN, MSN, E. Hood, RN, BSHCM, CIC,* E. Steimke, RN, MSN, CIC. VAMC and Medical College of Augusta, Augusta, GA. The Occupational Safety arid Health Administration’s final rule on “occupational exposure” requires the presence of a trained individual for education. This study compares the difference in post tes: scol-es when education is presented in person as opposed to on video. The sample included 492 Nursing s&ff, The 10 question test sought to evaluate knowledge of exposure risk. OSHA regulations, risk of HIV and HBV infecnon, and use of personal protective equipment. Verbal presentations were given by Infection Control Practitioners to 234 attendees; 25X attended a video presentation. Identical pre and post tests were given to both groups. Questions and answers were withheld from the video group until after the post test. Statistical analysis of both groups pretest scores revealed no difference at the 95% confidence level. Results: Post test scores of both groups were lugher than pretest scores, with a significant difference noted at the 95% confidence level. The average post test scme of the video group was higher than the oral group. however there was no significant difference at the 95% confidence levei. Goal-oriented programs on video result in learning, and are necessary Imethods with increasing requirements for education, and with time and personnel constraints.
EVALUATION OF THREE NEEDLE-LESS INTRAVENOUS THERAPY DEVICES. E. Owens, BSN,* E. Iademarco, BSN, M. Jones, BSN, S. O’Rourke, BSN, V. Fraser, MD. Barnes Hospital and Washington University Medical Center, St. Louis, MO. OSHA’s Bloodborne Pathogen Standard mandates engineering conlrols to limit needlestick injury (NSI). Multiple needle-less devices (NLD) have been recently introduced, however there is little data documentating product efficacy. We evaluated three needle-less intravenous therapy ([VT) systems for their efficacy in decreasing NSI in health care workers; 1) a ~metalblunt cannula (“Lifeshield,” Abbott Laboratories, Chicago, IL), 2) a plastic two-way valve system (“&f-Site,” Burron Medical, Bethlehem, PA), 3) a plastic blunt cannula (“Interlink,” BaxteriBD, Deerfield, IL). These deuces eliminate needies used to access IVT systems but do not elimmate the need for IV catheters, needles for injections, or phlebotomy needles. Barnes Hospttal is a 1000 bed tertiary care hospital with 54 nursing units and 600 reported NSIiyear. Between 6192 and 12192, 6 Imatched pairs of nursing units were prospectively randomwd to traditional IVT (control) or to one of three needle-less IVT systems (study). Ail umts received needle safety teaching, an on site NSI log for convenient reporting, and biweekly visits from infection control to promote NSI reporting. 20 NSI were reported from all areas during the study period. 15 (75%) of the reported NSI were related to activities that could have been prevented by a NLD. Activities included IV piggy back needle handling (30%), handling needles for line flush (15%). handhng loose needles (15%), blood drawing from a central (lo%), and needle disposal (5%). The Imetal blunt cannula group had 5 NSI compared to 3 in the control site @=NS). The iwo-way valve system had 0 NSI and their control group had 5 NSI (p=.O6223). The plastic blunt cannula study group had 0 NSI and the control grwp had 5 @=.01067). The metal blunt cannula group actually had more NSI than traditional IVT systems. The 2.way valve system had fewer NSI than their control group but this was only marginally significant. The plastic blunt cannula group had significantly fewer NSI than their control group. Differences in study groups were controlled by patient days and number of employees, but were difticult to assess given the small numbers of NSI. Further studies of these new devices are necessary to document their efficacy and justify their cost.